ABSTRACT
The purpose of this study was to examine the correlation between the changes in the lateral pillar grades and the factors influencing such changes. We reviewed 102 patients with Perthes' disease. Changes were observed in 32 (31%) hips. The percentage of the changes in each treatment group showed significant differences. Patients with extensive involvement showed significantly more changes. There was no difference in the age at the onset. We recommend that treatment methods be used that more effectively relieve the mechanical force on the capital femoral epiphysis for patients with extensive involvement regardless of the age at the onset.
Subject(s)
Epiphyses/pathology , Femur Head/pathology , Legg-Calve-Perthes Disease/classification , Legg-Calve-Perthes Disease/pathology , Adolescent , Age of Onset , Braces , Child , Child, Preschool , Epiphyses/diagnostic imaging , Epiphyses/physiopathology , Female , Femur Head/diagnostic imaging , Femur Head/physiopathology , Hip Joint/diagnostic imaging , Hip Joint/physiopathology , Humans , Legg-Calve-Perthes Disease/physiopathology , Legg-Calve-Perthes Disease/therapy , Male , Radiography , Range of Motion, ArticularABSTRACT
INTRODUCTION: The lateral pillar (LP) grade changes detected during treatment periods have received a lot of attention recently. Lappin et al. reported LP collapses in 92 of 275 (33%) patients during the treatment, but did not provide information for comparing treatment methods and age of onset of the disease. The purpose of this study was to review radiological changes in LP grade in older patients with Perthes disease during 20 months of treatment with skin traction and ROM exercises. We have also reported any grade changes in the posterior pillar (PP) classification. MATERIAL AND METHODS: Twenty-one patients with unilateral disease who were 9 years or older at the onset of symptoms had been followed until skeletal maturity. RESULTS: Out of 21 older patients with Perthes disease, our study had two (9.5%) who experienced LP collapse and two (9.5%) who experienced PP collapse during the first 20 months of treatment. The average time from onset to hospitalization in hips, initially classified as LP group C and PP group C, was significantly longer than in LP and PP groups A and B. The LP collapse in two hips and PP collapse in two hips occurred during months 4-8 of treatment. On the other hand, of the patients allowed to ambulate with the Pogo stick orthosis from months 8 to 12 and without a brace from months 10 to 15, none had a collapse of their LPs or PPs during these periods. CONCLUSION: Lappin et al. reported that 92 of 275 patients (33%) who were managed conservatively in several hospitals experienced LP collapse during their treatment periods. Our results suggest that older patients with this disease treated with skin traction and ROM exercises rarely suffer a LP collapse, as compared with the Lappin et al. report.
